Abdominal abscess in Crohn's disease: multidisciplinary management

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Internal Medicine

Background:

• Crohn's disease (CD) involves full-thickness bowel inflammation, leading to common perforating complications like intra-abdominal abscesses.
• Managing intra-abdominal abscesses concurrently with active small bowel CD presents a significant clinical challenge due to the risks of immunosuppression.

Purpose of the Study:

• To review and outline the optimal management strategies for intra-abdominal abscesses in patients with Crohn's disease.
• To compare the efficacy and safety of different treatment modalities, including antibiotics, percutaneous drainage, and surgery.

Main Methods:

• Review of current literature on the treatment of intra-abdominal abscesses in Crohn's disease.
• Analysis of treatment outcomes, success rates, and complication profiles for various interventions.

Main Results:

• Percutaneous drainage with antibiotics is the current first-line treatment, with success rates ranging from 74-100%.
• Surgery may be avoided in 14-85% of cases following successful percutaneous drainage.
• Delayed surgery, when required, in conjunction with percutaneous drainage, improves patient condition, reduces morbidity, lowers stoma rates, and allows for more limited resection.

Conclusions:

• Percutaneous drainage and antibiotics are the recommended initial treatment for intra-abdominal abscesses in Crohn's disease when feasible.
• Delayed surgical intervention is crucial for patients with refractory disease, stenosis, or fistulas to minimize septic complications and stoma formation.